do i have a chance?--need help

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turquoiseblue

turquoiseblue

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I was in a past program and resigned--it was a pretty malignant place, and I just got scared, so I left in the middle of the year. They gave me credits for all months, but no letter about it, just verbally told me that they would. I asked to resign, they didn't force it on me. If you really want to know more in detail, PM me, because I don't want to talk about it in public. Why did I resign? I just didn't know any better, and thought I could find a better, less hostile program later. On paper, I just wrote "for personal reasons". Overall, I just want some positive helpful advice.

My main question is: there any way I can get back into residency again?

I have tried the last few matches and got 1-2 interviews, last year nothing from the NRMP match, but never got back in. I've done a year of research with first-author publications, and 8 months of an externship since I left the program, and currently studying for step 3. I went to a carribean medical school and am a U.S. citizen, so I don't see the problem with getting a position--all my collegues did fine. Is there a way I can somehow get connected to a program? Do they blacklist you to make sure you never get into residency again? How should I put this on my ERAS when they say "why did you leave"? Is there anything else I should be doing now to help me get a position?

I guess my grad date is just getting further and further away too, so that isn't helping. Will step 3 help my chances or not much?

Also, if anyone has any lead to a program--any specialty--please PM me. I would really appreciate it. I feel like my dreams and hard work from medical school are gone, even though I keep trying every year. I don't want to do anything else, because when I do I'm pretty much miserable and miss clinical work.

If anyone has any options for relevant jobs out there I could do in the meantime that would boost my CV, please let me know. I really don't know what to do right now. Just flailing around like a fish out of water, drying out.

I found some jobs in medical writing, would that help? What other options are there?
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What are you applying for? I have a hard time believing that a FP, IM, Peds, or Psych program out there in the depths of a place that NOBODY wants to live will not take you?


I would certainly think Step III would be a huge plus. Other than that, I'd say strong communication with PDs will be key. Look at the podunk programs in places where nobody wants to go. The training there will not particularly be 'bad' but they certainly would have a much harder time getting the mainstreamers there and just might give you a shot....if you at all personable and such in the interview.


Good luck; your situation sucks.
 
Are you sure your original program isn't blacklisting you for leaving in the middle of the year? Have you been able to acquire strong letters of recommendation from them?
 
Thanks for the responses. I applied for IM and surgery and some FP. I guess I haven't really applied to a lot of FP. I should really try that next time around.

I'm not sure if my program is blacklisting me. I wish I knew. Maybe just the fact of leaving a program looks bad and not even questioned, just ignored. I was originally in IM. I could only manage to get one attending to write me a decent LOR, the rest acted like they didn't know me long enough, even though I worked with them for the month.

Next, I was in an externship in surgery after that and got some nice LOR's to hopefully prove the other program wrong, but it didn't seem to help anything in getting another position. In fact I got no NRMP interviews this time.

I was surprised even after clinical work where I did everything a PGY1 has to do and extra LORs---nothing!! and this was at a pretty prestigious type hospital. I still applied to only programs my scores qualify for though...they're not all that great.

I did not put my past PD letter from IM in ERAS though. I think I'm just afraid to send it because there are some negatives like "low satisfactory", and calling it suboptimal, rather than just saying plain satisfactory, which is what it really is. Suboptimal means less than satisfactory, but that isn't true--- yet in the end of the letter he said he supports me in getting another program. Then again he was an associate PD, not a real PD, but they acted like they were the PD's so I'm hoping his letter counts. I guess it doesn't hurt to try though--its just that if won't work and still looks bad, that's another year down the drain. I wonder if I can have him rewrite it? but he's no longer the associate PD...

My actual PD left before I did, and he wrote everyone a letter, stating he wanted to work at another program--pretty odd leaving like that. I guess I followed his lead! So I don't have any letter from him or even the chairman because they never oversaw us--only the associate PDs. I don't think he even liked it there.
 
why dont you try to track down your actual PD and get a letter from him?
at this point, i think it would be good if you could closely assist a faculty member who will a)allow you to shadow him, b) write uber great LORS, c)make calls for you.

leaving in the midst of internship is a red flag to PDs, so you need someone to soften that red. Of course, getting buddy-buddy with an actual PD is a huge softener.

also if in the interviews you are asked about why you left, i would suggest that you don't bad mouth your program as much (even if it certainly deserves to be) because that in itself is a red flag too. maybe you can say something like, "I left because of personal reasons beyond my control..." with a quick follow up, "Before I left, I made sure I informed my PD and my program, and though they were sad to let me go, they understood and assured me that I would receive credit for all my work." And then divert it into, "I believe this speaks of my capacity as a resident and team player, and though it may appear as a red flag, I hope you can also view my actions in the light that I respect my program..."

good luck:luck:
 
turquoiseblue said:
I was in a past program and resigned--it was a pretty malignant place, and I just got scared, so I left in the middle of the year. They gave me credits for all months, but no letter about it, just verbally told me that they would. I asked to resign, they didn't force it on me. If you really want to know more in detail, PM me, because I don't want to talk about it in public. Why did I resign? I just didn't know any better, and thought I could find a better, less hostile program later. On paper, I just wrote "for personal reasons". Overall, I just want some positive helpful advice.

My main question is: there any way I can get back into residency again?

I have tried the last few matches and got 1-2 interviews, last year nothing from the NRMP match, but never got back in. I've done a year of research with first-author publications, and 8 months of an externship since I left the program, and currently studying for step 3. I went to a carribean medical school and am a U.S. citizen, so I don't see the problem with getting a position--all my collegues did fine. Is there a way I can somehow get connected to a program? Do they blacklist you to make sure you never get into residency again? How should I put this on my ERAS when they say "why did you leave"? Is there anything else I should be doing now to help me get a position?

I guess my grad date is just getting further and further away too, so that isn't helping. Will step 3 help my chances or not much?

Also, if anyone has any lead to a program--any specialty--please PM me. I would really appreciate it. I feel like my dreams and hard work from medical school are gone, even though I keep trying every year. I don't want to do anything else, because when I do I'm pretty much miserable and miss clinical work.

If anyone has any options for relevant jobs out there I could do in the meantime that would boost my CV, please let me know. I really don't know what to do right now. Just flailing around like a fish out of water, drying out.

I found some jobs in medical writing, would that help? What other options are there?
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sorry about your situation, ouch

what did you do after you left the program besides med writing?
 
why do you wanna get back into medicine.. just find a job.. enjoy your life.. seriously.. dont look back
 
hey you are not alone, I was in IM program too; strong program but not very friendly to "outsiders"(not from that area) especially if you have the brains and the potential for success.
Started looking for another program to transfer after completing 2nd academic year...they found out, got as you said malignant; so I end up resigning in the middle of the year.
I did not leave on bad terms. Some attendings I worked with were "shocked" that I left, wrote great letters of recommendation for me.
PD promised (verbaly) to send only good recommendations, but so far no interviews
from any 15 programs I've applied to. I'm starting to wonder about so called "black list".
Makes me wonder why can't some people just step down on the real ground for a moment from their administrative positions; recall their residencies, possible hardships and struggles, achievements and falls;
and think like real people with their potential happiness and sadness, sickness and health, emotional and financial issues, families, kids, parents, friends, pets, etc...
I believe in karma (what goes around comes around). If someone now is making your life(and mine as well) miserable, they forget about karma turning back to them and their family.
If you know you did not make anybody hurt or suffer for any reason something good will come up soon. I want to believe in that, that is what I have left to do.
Medicine is my life. I can't imagine my life without it. I know how you feel, and want to say: DO NOT GIVE UP! It may sound lame but there are patients somewhere waiting for you to be their doctor. We'll find a way to finish and practice. And will be successful no matter what.
And when it is over and done don't you ever forget about this time in your life,
and always try to help somebody struggling like you are now.
I'll be glad to talk if you want to.
 
theCamel said:
sorry about your situation, ouch

what did you do after you left the program besides med writing?
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-A year of research with some publications, some of which are still being submitted

-8 months of an externship in surgery. Hospital was prestigious. Nice LOR's.

-got ill...had hypothyroidism with really severe symptoms...didn't see a doctor until it was too late..took a while to recover...was unable to have a job during that time because of meds I had to be on that make you drowsy all day, even with added stimulants....meanwhile hardcore studying for step 3..still am studying for it...i feel like I'm ready now...will take soon. That makes a year gap of no work though. I have a good reason though--We're all human right? Doctor's can get sick too!

-I finally recovered, back to my normal energy levels and able to wake up in the morning, and now found a job in medical writing that is currently about to hire me....they've been stalling me..for a while now..still waiting.

I sent out my CV to many PD's and I keep hearing that there are gaps in my record and the past program is a red flag, despite anything else I added to it.

It's hard to have much hope after you even go to Hopkins and get published. I thought that would make the home run! Sometimes I wonder does it intimidate a program to hire someone that had experience at a place like that?

I guess God giveth and He can taketh away too!! :( Hope He giveth again :)!

i tried podunk places all over too and nothing!

I don't see what is so wrong with my CV--I added many credentials....grrrr.

But I hope that answers your question...
 
Being a little lost myself after medical school, it seemed every door was closing on me, I went through a down phase. It was a huge kick in the gut to get turned down for what I considered were measly posts. Definitely a humbling experience. The best advice I got was someone telling me that maybe it was not about me. It was not about my credentials or my attitude or my timing. Maybe I just really had to learn a lesson in humility and down-time. Get the chance to think which ladders I really want to climb, instead of just climbing, climbing, climbing. So that is what I hold on to, and just trust that maybe Life is a waaaay better planner than I could ever fathom. I realize now that if I had been given one of those posts, I might not have had the time or the interest to pursue residency here in the US. I would not be applying for a working visa, a new apartment, etc. I would be in a different place. Of course there is still a part of me that wonders what could have been, but it's useless now. I figure there must be a reason why God wants me to meet Uncle Sam, and He has made it possible despite so many nuances of mine, so I'm waiting to see what He has in store for me. In any case, what goes up, must come down, and what is down, can only go up :D

Remember, "when fishermen can't go out to sea, they build their nets..." and "when in deep water, become a diver..." I forgot where I got those, but I love them ;)
good luck! :luck:
 
Sounds like that would make for a nice personal statement ;)

True, if i didn't leave that program i wouldn't have had these experiences of what I've always wanted to do in addition to medicine....i finally got it out of my system....it was all just a surreal experience...

Now I want to go back to clinical medicine. i think I deserve to be a doctor in clinical medicine working with patients--not a part-time $5/hr lab rat not even getting benefits, mooching off parents to pay the rent. and even that is good, because a lot of places only allow you to volunteer only. I mean that was a great experience to write papers, but there's a point when you're like um I'm an MD for gosh sake---I'm supposed to be seeing patients, or own my own lab, be finishing residency by now, etc. Where is all that pie I'm supposed to get with the MD package I worked so hard for?

Something needs to seriously be done. The system isn't right to do this to residents and leave them to wither away trying to find a job--and there aren't many jobs out there made for MD's unless it's pharma, teaching or research. and that's not what I want-I want clinical..how can they ruin your dream? we went to med school, that should be respected and cherished not thrown away like garbage.

Right now there is nothing to prevent this from happenning to anyone--no programs to remediate residents or help them in difficult situations, they're just thrown out like trash. I wans't thrown out though--i left, and that shouldn't be a crime to jump from a ship of pirates. I know quite a few who's lives were absolutely ruined like this --never to find residency again...living in complete anguish of being an MD but having to settle for a job they never wanted, yet only just starting their residency. They apply for the match spending a fortune every year getting no interviews, still with hope--Truly sad! Also having a physician shortage, yet not making enough residency spots to fill that shortage does not make sense at all, and some doctors don't even practice clinically after they finish residency. Serious change needs to happen. I guess I can only wish.

Actually there was this retired MD that had a connection at a program that I'm going to hear back from in 3 days!! Hope I hear what I want to hear :)

Thanks for the luck and advice :)
 
turquoiseblue said:
I was in a past program and resigned--it was a pretty malignant place, and I just got scared, so I left in the middle of the year. They gave me credits for all months, but no letter about it, just verbally told me that they would. I asked to resign, they didn't force it on me. If you really want to know more in detail, PM me, because I don't want to talk about it in public. Why did I resign? I just didn't know any better, and thought I could find a better, less hostile program later. On paper, I just wrote "for personal reasons". Overall, I just want some positive helpful advice.

My main question is: there any way I can get back into residency again?

I have tried the last few matches and got 1-2 interviews, last year nothing from the NRMP match, but never got back in. I've done a year of research with first-author publications, and 8 months of an externship since I left the program, and currently studying for step 3. I went to a carribean medical school and am a U.S. citizen, so I don't see the problem with getting a position--all my collegues did fine. Is there a way I can somehow get connected to a program? Do they blacklist you to make sure you never get into residency again? How should I put this on my ERAS when they say "why did you leave"? Is there anything else I should be doing now to help me get a position?

I guess my grad date is just getting further and further away too, so that isn't helping. Will step 3 help my chances or not much?

Also, if anyone has any lead to a program--any specialty--please PM me. I would really appreciate it. I feel like my dreams and hard work from medical school are gone, even though I keep trying every year. I don't want to do anything else, because when I do I'm pretty much miserable and miss clinical work.

If anyone has any options for relevant jobs out there I could do in the meantime that would boost my CV, please let me know. I really don't know what to do right now. Just flailing around like a fish out of water, drying out.

I found some jobs in medical writing, would that help? What other options are there?
Click to expand...

So when you left your program, did you talk to your pd beforehand to get his/her support? Did you give any notice before you left or did you just up and leave one day? I don't understand why you would leave a program, especially as a fmg in the middle of your intern year without having another program take you...
 
I gave notice..I voluntarily told them I'm ready to leave. I was stupid thinking that I could get into another program.

Ok it is a long story but initially i was on departmental probation (not the official one) because they stated that i didn't call my seniors. I did call them all the time like I was supposed to, but some of the seniors were pretty on my case all the time, and told exaggerated stories about me to the PD behind my back and I knew because I'd hear back from the PD. There were a couple times I tried to call the seniors when there was an emergent situation going on, but they were late for work....and then the emergency got blamed on me...because they weren't around. Yeah there were on and off things I didn't know about--of course! because I was just starting as an intern, plus started off a month later than July because I scrambled in--thats another thing--they were always hawking me because I was the new one. People were maligant there though, all they cared about was covering for themselves, and usually it was an exaggerated report. e.g. stating that I overdosed a patient on radiation, just for ordering a CT (with the permission of my senior, which I think she later suddenly denied--people would lie there and backstab)--it was for a patient with possible P.E. I mean i was always called to the PD's office to deal with these residents' blaming stories so they could wipe their hands clean.
There's more accusations for stuff like that..i wont go into too much detail.
So basically it piled up on me...and it made it look like I'm that bad of a resident but I worked really hard and did all my work. its not hard to be an intern, and they shouldn't have been bothering me like that trying to make me look bad over minutia that no one cares about. I saw a guy get away with giving a patient vit K and messing up his coags, or get away with not answering pages to a patient for 2 hours, and I was the one that got in trouble because the nurse called me and I went out of concern, thenn i got in trouble for answering my pager afterhours--sure I learned my lesson but the other guy didn't get in troule at all . i felt targeted. i could go on and on but i will spare you from writing a novel.

So meanwhile I was dealing with nurses on my case all the time threatening to report me to this or that, just for small minute things that no one else gets into trouble for. One day a nurse seriously made a huge report on me just because we got in a disagreement--she thought I left some needle in the room and i was like no, i recall throwing it away...she kept saying she could have been stuck--there was never any proof it was my needle either...it could have been anyones--no one investigated--usually no one will get in trouble for that--the nurse would usually just let it pass and remind the intern about it and let go, but these nurses were aim, shoot, kill....i had even done extra work for her--she had me do an IV that she didn't even bother to try first which she's supposed to do--that was the appreciation I got....i was nearly suspended for it but I opted to leave at that point because I was like this is so unfair--I had no one to turn to, no one teaching me hardly anything, just surrnounded by a bunch of mean self centered people, that I wanted to get out of there. I went to do an externshp elsewhere and people were so nice there, willing to teach, no reports on me just for asking a question. Got Good LOR's from there.

It's ridiculous. Our residency system absolutely STINKS! I can't believe no one is doing anything about it and they keep looking at me like it's all my fault, won't let me back to a program. My program kept uttering 'interns don't have to know anything'

well yes i performed awfuly on the inservice exam---33%...but I was sick and sneezing all over my test constantly with a drippy nose literally like a faucet and I was fasting that day starving to death, (i ended up eating in the middle realizing it was too much torture on myself) and not to mention, I asked the cheif if i should study for it and if it counted, and what's a good way to study for it, and he was like no don't worry about it...it wont count, so I didn't take it seriously. Then later im sure he'll go on and say well it's actually serious. but i didn't hear anything about it...so not sure if it was my make or break.

I can admit i wasn't all the way there because I was finishing up an MBA too, but was done by November. but they asked me to quit the MBA a week before graduated and i didn't and i think they got mad at that. that's my personal life-- they shoudln't be on my case if I am almost done with it. I finshed with a 4.0 to their dismay. im sure doing that at the same time as residency affected me because I wasn't able to go over my patients at night..maybe just briefly...but it was all scut anyways--the attending just had us write and carry out his/her orders and that was that...what is so hard about that? this was a conspiracy of ocd minutia that no one gets in trouble for. i had malignant type seniors.elsewhere i ddin't have to have that problem.

i could go on forever....so i hope you can see why i left. it was on good terms, they gave me all my credits....i wanted a fair trial before they would suspend me and they said no you will have this on your record whether you win or lose, so i was like this can't be happening and I just left....because i was scared what else are they going to do to me...they had already told me i was doing well during the probation, and now this? wel i can at least vouch that they said I was doing well and it wasn't due to my knowlege...i think it wasj ust because they didn't like me...really i've never been around so many mean rude selfish backstabbing people before...something was really wrong with that hospital and I could not stand being there another minute for them to slowly ruin my career forever...i mean after suspension who knows termination? i didn't want to stic around to find out---so thankfully i have no suspension on my record....at least...because i felt that was so uncalled for....i am a nice hard working person..i felt so prejudged...and i can't believe they let nurses ruin residents like that...the nurse took it to the CEO==so the PD's couldn't do much about it and probably wanted to save their job, because I think that other PD may hav e been fired--who knows--why else would he leave midyear for another job..maybe he's covering something up..i heard a lot of attendings were being fired as per some administrative woman that was chatting with the nrses..people really had inner connections to higher powers, and liked to use it..it was a community hospital so there weren't many resources for me to tap into to get help....it is unfortunate that I scrambled there. if i would have been in another program I am sure things would have been so much more different.
 
turquoiseblue said:
well yes i performed awfuly on the inservice exam---33%...but I was sick and sneezing all over my test constantly with a drippy nose literally like a faucet and I was fasting that day starving to death...

I can admit i wasn't all the way there because I was finishing up an MBA too, ... im sure doing that at the same time as residency affected me because I wasn't able to go over my patients at night
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Let me start by saying that I initially felt incredibly sorry for your situation and I completely appologie if I seem like an a**hole. I don't know you, but from this post, I'd say you may be better off not going back to medicine. To me, you seem to lack integrity, have no dedication, have a sense of entitlement, and make excuses for all of your short-comings (maybe add dishonest- with yourself and to others). None of these are qualities I'd want in a resident or anyone taking care of me.

In previous posts, you've said it's your right to be a clinician because you went to medical school.... :eek: uh, no! You have to earn your right to treat patients by dedicating yourself to them. This includes STUDYING to pass in-service exams. We've all taken important exams when we were sick... if you know your stuff, you'll get above a 33%. Being sick/hungry may have a mild effect on your score, but a 33% proves you just were not prepared.

Getting an MBA during your intern year? Seems like you're more dedicated to money than to patients. I find it hard to feel sorry for you if you chose to study business over checking up on your patients.

With all of your credentials, I'm sure you can have a successful job in healthcare, I just wouldn't want you taking care of me or anyone I care about.

Patient care is a privilege, not a right.
 
kirurg said:
To me, you seem to lack integrity, have no dedication, have a sense of entitlement, and make excuses for all of your short-comings (maybe add dishonest- with yourself and to others). None of these are qualities I'd want in a resident or anyone taking care of me.
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You may have a different experience than I as an intern, but I've seen some of what the OP is talking about first-hand, and I think the jump to label him/her as entitled and lacking dedication is a little quick.

Sometimes residents get snow-balled. They screw up once or twice, maybe piss off too many nurses or irritate a chief. Next thing you know the grapevine kicks in, and every little oversight instantly becomes fodder. Things that everyone else gets a pass on (taking too long to answer a page, minor med errors, getting notes in late, conflicts with nurses) suddenly become issues that require a sit-down with the PD. It's like blood in the water.

Sometimes this is deserved, but not always.

I don't know if this intern sucks or not. But I've seen two very good residents from other programs get absolutely railed for things that the rest of us get away with every day. The truth is that interns and residents make mistakes and violate the morass of hospital and GME policies almost routinely. Anyone of us could be expelled at any time if people were interested in finding a reason.

Oh, and for the record, a 33% isn't good on an inservice training exam, but it's also not horrible. At least one of our local Gen Surg programs use 20% as the cutoff for academic probation. Remember that this isn't a raw score, it's a percentile.
 
kirurg said:
Let me start by saying that I initially felt incredibly sorry for your situation and I completely appologie if I seem like an a**hole. I don't know you, but from this post, I'd say you may be better off not going back to medicine. To me, you seem to lack integrity, have no dedication, have a sense of entitlement, and make excuses for all of your short-comings (maybe add dishonest- with yourself and to others). None of these are qualities I'd want in a resident or anyone taking care of me.

In previous posts, you've said it's your right to be a clinician because you went to medical school.... :eek: uh, no! You have to earn your right to treat patients by dedicating yourself to them. This includes STUDYING to pass in-service exams. We've all taken important exams when we were sick... if you know your stuff, you'll get above a 33%. Being sick/hungry may have a mild effect on your score, but a 33% proves you just were not prepared.

Getting an MBA during your intern year? Seems like you're more dedicated to money than to patients. I find it hard to feel sorry for you if you chose to study business over checking up on your patients.

With all of your credentials, I'm sure you can have a successful job in healthcare, I just wouldn't want you taking care of me or anyone I care about.

Patient care is a privilege, not a right.
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Little integrity? you don't know that. How can you know that. I worked hard there. I did the MBA not for money but to have more credentials, but i realized it doesn't help . i didn't even like getting the MBA but I was too far into it to quit. As i already said I would rather be in residency. Plus you are a PGY0. You haven't even been there yet.
 
Tired said:
You may have a different experience than I as an intern, but I've seen some of what the OP is talking about first-hand, and I think the jump to label him/her as entitled and lacking dedication is a little quick.

Sometimes residents get snow-balled. They screw up once or twice, maybe piss off too many nurses or irritate a chief. Next thing you know the grapevine kicks in, and every little oversight instantly becomes fodder. Things that everyone else gets a pass on (taking too long to answer a page, minor med errors, getting notes in late, conflicts with nurses) suddenly become issues that require a sit-down with the PD. It's like blood in the water.

Sometimes this is deserved, but not always.

I don't know if this intern sucks or not. But I've seen two very good residents from other programs get absolutely railed for things that the rest of us get away with every day. The truth is that interns and residents make mistakes and violate the morass of hospital and GME policies almost routinely. Anyone of us could be expelled at any time if people were interested in finding a reason.

Oh, and for the record, a 33% isn't good on an inservice training exam, but it's also not horrible. At least one of our local Gen Surg programs use 20% as the cutoff for academic probation. Remember that this isn't a raw score, it's a percentile.
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Thanks for understanding, tired. I was an oddball for being a US citizen. I even got called out 'you probably made it in because ur a us citizen'. I was told that I was expected to be the star for that, when I thought I'm just like anyone else, no better. So there was an element of not fitting in quite right. I usually get along with anyone and I work hard and do all my work, but this was just kind of a weird situation. and yeah i probably did terrible at first because when you start off, its nothing like med school, but eventually I caught on. I started off a month later than everyone. I mean they told me i was doing well during the probation, so that showed I was almost out of the mess until this nurse whacked me with a report that threw everything off, so out of fear i left. It's just sad that it is permanently there forever as a nonhealing scar, even if you moved on and learned more or improved, gained more credentials, etc.
 
Ok, ok...remember we're all just relying on words written down here so I don't think anyone of us should be judging who would be the horrid MD, which probably will vary to a certain degree from person to person.

IMHO, it's very hard to combine internship with something else, especially something as demanding as an MBA. And maybe that would, in part, contribute to the low in service exams. I can also understand why your program would ask you to quit. It's a tough juggling act that may have left them feeling you weren't giving them your all. But what's done is done, and you just move on.

I don't think having an MBA makes you money-centered and unconcerned with patient welfare per se. If you really want to pursue the clinics go for it. I think it's only because the MD-MBA is such an untrodden path that people wonder why you don't pursue careers more related to it. But you technically don't have to answer to anyone but yourself and whatever it is you believe in. Good luck:luck:
 
kirurg said:
To me, you seem to lack integrity, have no dedication, have a sense of entitlement, and make excuses for all of your short-comings (maybe add dishonest- with yourself and to others). None of these are qualities I'd want in a resident or anyone taking care of me.

Getting an MBA during your intern year? Seems like you're more dedicated to money than to patients. I find it hard to feel sorry for you if you chose to study business over checking up on your patients.

Patient care is a privilege, not a right.
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Kirug, I beg to differ. Tired is absolutely correct. I am at the other end of the pipe, and looking back on the system, I do not like what I see.

The simple reality is that the interpersonal dynamics and hierarchy of residency/internship is far more complex than you make it seem. you have not yet experienced, the gruel of graduate medical education. You will have it far better than those of us who started in the bad old days of 110+ hour work weeks and 40+ hours on call.

Medicine, and in particular academic medicine has more than its fair share of very bright people who have become powerful, despite being ill-suited for those positions because of the nature of the medical education process. Unlike industry/commerce, leaders in medicine, because of the nature of the "training" process attain that rank in residency by keeping off the radar, and by being present.

Some, not all, but some of these people are malignant, closeminded and can be more vicious than a schoolyard bully. They can act with impunity, as they are more senior by as little as one year, and the system has been rigged to give lip service or less to those who become the goats, for legitmate or imagined transgressions. And once a goat, always a goat.

As has tired, pandabear and others, including, from the sounds of it, the OP, I have seen and experienced this first hand. As a faculty member, I have seen this behavior foisted on other faculty members who had the integrity to report that the "emperor had no clothes." This process does not appear to stop at residency, in some institutions.

So, I although I am appalled that I continue to hear of and read of these situations, I am not in the least bit surprized by it. I hope that the program you eventually end up at has none of this. If it does, I hope that you, from a position of safety, will be able to do something about it, rather than become part of the problem, or will at least be able to survive it.

A lot to learn, you have, my young paduin. Arrogance and pre-judgementalism, these are the ways of the dark side.
 
Turquoiseblue, you do have a chance, but you are now "outside" the system. This will take perserverence, ingenuity and a bit of luck or providence, depending on your perspective. Getting a second chance is getting more difficult these days because of the increasing number of applicants for residency positions, but still not impossible.

Here are the adverse factors:
1. You did not complete the "internship." To many program directors, the completion of the internship year however awful the program was that you were in means you are proven in battle. Since you are not proven in battle, people will be suspicious. You will have to do what you can to ease those suspicions. Letters of reference and actual phone calls on your behalf from those whom you worked with and support you may help. You must be absolutely certain these people will be completely honest with you and with those whom you ask them to speak.

2. You have been away for a time. This is increasingly a roadblock, but it too can be overcome, if there is good evidence of perserverence.

Your success at getting another position will depend on your personality, your willingess to think creatively outside the system, as you are no longer a first round draft pick in the match, a lucky break of finding a program with an open position at the time you call on them and your ability to convince a program to take a chance on you.

It will take salesmanship on your part. The hardest thing to sell is yourself. [Psychiatrists, feel free to chime in here on the reasons why.] You may decide to make some cold calls on PDs in your area, asking them for an unbiased second opinion on your situation. If you do, get a couple of them. Remember, though that many of them know each other from the regional meetings and may be personal friends. Listen carefully to what they say, then do the same in another region of the country, away from the local politics. Your purpose in doing this is not to harrangue your former program, justified though that may be, but to gaininsight into yourself and your situation. Identifying the program's shortcomings will be counterproductive to this and may come back to bite you.

Then tailor a search based on what you've learned. Many eventually do get a break and go on to succeed. Learn from what happened, be prepared to discuss candidly your contribution to it and how you will be able to overcome these issues amicably your future residency and you might have a shot at landing one. It may take time. Perhaps much time.
 
3dtp,
Thanks for the advice and encouragement. I will start calling up PD's. I did email some PD's, and some say they consider having a past program as a red flag, but I will try some more, maybe even in a different specialty. I hope that step 3 will also help--I plan to take that soon. Right now I'm studying for that.
 
I apologize for being so judgmental. This is why I prefaced my post with saying I don't know the OP.

I am not a resident yet, but I have worked with many during rotations. It was obvious that some of them cared more about having the title of "doctor" than they cared about their patients' welfare. That was the vibe I was getting from the OP ("im sure doing that [MBA] at the same time as residency affected me because I wasn't able to go over my patients at night"). My opinion is that nothing should be more important than our patients, and if they are not our top priority, we do not deserve to be their doctors. If she really is sincere, than I wish her all the best.
 
no its not the title i care abt..i went to med school for a reason...to help patients...i did the mba just so i could get in...thats all i cared for that degree....but in the end it probably dint boost my credentials anyways...whos to say that mba didnt help me get that interview and spot...i dont see why anyone should b judged for having an mba or being in a situation of having to finish that mba that i couldnt really get out of. no one reads all day long on their patients..they sit home watch tv vegetate gossip to friends take care of their family or go out... whatever..i used that time to finish up an mba i was stuck in...i did go over patients when i could though..being an intern is almost a no brainer..u just follow orders...no one follows harrisons to the T.....plans vry every day and patient status constantly changes so theres no way u can predict a patients care...especially when they are critical..i wasnt lazy by far..i actually cared about my patients..some wated my card..they were shocked i was leaving....u live day to day depend on attendings plans and u learn through that...thats what residency is all abouut..learning the reality....is not cookbook medicine all the time...
i would have gotten through if it wasnt for that nurse.
 
turquoiseblue said:
3dtp,
Thanks for the advice and encouragement. I will start calling up PD's. I did email some PD's, and some say they consider having a past program as a red flag, but I will try some more, maybe even in a different specialty. I hope that step 3 will also help--I plan to take that soon. Right now I'm studying for that.
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Welcome. If it is at all feasible, you might want to make at trip over to their institution and visit in the flesh. I think that there is no substitute for a one on one face to face conversation where they have a chance to see you, observe your body language and get to know you. Might not work, might even backfire, but it will also give you insight into what you need to do to get yourself back on track.
 
kirurg said:
I apologize for being so judgmental. This is why I prefaced my post with saying I don't know the OP.

I am not a resident yet, but I have worked with many during rotations. It was obvious that some of them cared more about having the title of "doctor" than they cared about their patients' welfare. That was the vibe I was getting from the OP ("im sure doing that [MBA] at the same time as residency affected me because I wasn't able to go over my patients at night"). My opinion is that nothing should be more important than our patients, and if they are not our top priority, we do not deserve to be their doctors. If she really is sincere, than I wish her all the best.
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Didn't mean to put you on the spot man. Sorry about that. I think you'll do fine wherever you end up. I wish this forum was around when I was first getting started. One of the real problems though is the loss of nuance in written spontaneous electronic forums.

I observed similar things, or so I thought as a senior med student. Then I crossed the line into residency and whoa did my eyes get opened. I suspect that this will happen to many. I admire and encourage your attitude of patient's first. It will serve you well.

A rhetorical question (ie no need to answer, but certainly useful to think about): Is there a guarantee that hospitals really put patients first when revenue or costs or egos are at stake?
 
First, you have to realize that what the "seniors" and PD say have more way more weight than an FMG in internship. If they said that you don't properly call senior residents then a PD would conclude that you lack judgment about when you are in over your head. No one is going to take the word of an FMG that it was all trivial stuff.
 
DarthNeurology said:
If they said that you don't properly call senior residents then a PD would conclude that you lack judgment about when you are in over your head.
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Unless you document it.

The nurses CYA every fricking hour of every day. So should we.

When you have a situation serious enough that you have to call your senior, drop a note in the chart. It doesn't have to be anything more than a couple sentences.

"Called by RN for hypotension. Assessed patient, BP 80/40, delerious. Meds reviewed, no recent narcotics, metoprolol 50mg PO last administered 1hr ago. Normal temp. Physical exam unchanged. Started fluids, ordered q15min BP x 2hrs, requested RN call for any change in clinical status. Notified R3 on-call of patient's status."

I have seen interns avoid playing the scapegoat for putting these kinds of notes in the chart, and I do it religiously.
 
Tired said:
Unless you document it.

The nurses CYA every fricking hour of every day. So should we.

When you have a situation serious enough that you have to call your senior, drop a note in the chart. It doesn't have to be anything more than a couple sentences.

"Called by RN for hypotension. Assessed patient, BP 80/40, delerious. Meds reviewed, no recent narcotics, metoprolol 50mg PO last administered 1hr ago. Normal temp. Physical exam unchanged. Started fluids, ordered q15min BP x 2hrs, requested RN call for any change in clinical status. Notified R3 on-call of patient's status."

I have seen interns avoid playing the scapegoat for putting these kinds of notes in the chart, and I do it religiously.
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That would probably help some *internally*, i.e. if it has the time and date you could say you did notify the resident but you are presuming that it is an isolated incident and that you have time to recall the chart from medical records, . . . I would think in this case the PD would say that the intern has a pattern of not calling for help appropriately, no documentation can refute a general statement like that and the resident is screwed for life period. Also, I would think if you used your little notes in the chart to get out of one situaiton it would make the senior residents P.O.'d that you are documenting something that could get them in big trouble if the patient goes south while they are in the O.R. or something. I would think the above note is insufficient as it doesn't say how much fluids you started or if there was pulmonary edema or signs of heart failure, so you can also get in trouble if someone looks hard enough! Sounds like you need to hold the metoprolol and do more than monitor vitals q 15 minutes, i.e. you may need an arterial-line placed, and I would page a second residents if the first chief doesn't answer back and maybe an attending for this one, a delirious patient with a blood pressure of 80/40 is much sicker than an OK neurologically intact patient with a blood pressure of 75/35 . . . at least in my book. I know it was just an example, but, the situations were an intern really needs an upper level resident are the ones where none are to be found and you have to get someone like another resident or the attending, I am sure the surgeon would really want to know about this patient regardless of time of day.
 
I would think at least documenting that you paged a senior and tried your hardest to get help shows that you at least call for help, whether they answered the call or not, and then documenting (as a brief SOAP note) what you did should help if anyone is in question that you even did anything at all.

If others want to scrutinize what was done, that is another story. As long as you discussed with a senior that should say it all and defer all blame to the senior to cover themselves from there. ;) (no offense to the seniors).
The senior could then write another note or the resident could write that the senior agreed with their plan, or reassess as discussed with the senior. That way everyone is covered.

****
I've once asked another senior in ICU for help on the wards, because a patient was crashing--i thought he should go to the ICU and it turns out he really did, but the ICU resident wouldn't even bother to listen, because he was worried about his other patients, and he would not help me because he wasn't my resident..I actually didn't have a resident that night for some reason...i think it was that i was working overtime because the nightfloat guy woudln't come answer his pager for hours, so officially i was supposed to be gone, but no one was caring for this crashing dying patient. I stayed there out of concern whether I was supposed to or not--i just didn't want this patient to die out of neglect. (later on i was called to the PD's office and got in trouble even though i was trying to save this guy's life..i mean i saw so many patients die on nightfloat, so I didn't like to leave my patients).

I actually walked down to the ICU to tell this ICU resident off because who leaves people to die in a hospital like that.because he kept blowing me off on the phone..not believing me....eventually he understood and called a resident up there....about an hour later the ICU resient calls in for someone else to come up (which took a long time for him to get up there), but during that one hour he was arguing with me how he can't even deal with that problem and I have to have a resident call him first, and that I cant call him. I didn't have a resident so I was so scared this patient was going to die due to crazy politics. He was my day patient so I didn't want him to die because nightfloat doesn't want to deal with him. He was HIV , a hard stick, SOB, ascitic, his ABG was out of whack, sats dropping, couldn't get a CT because he didn't have the veins to get contrast (was an IV drug abuser), GI was arguing with surgery daily whether he should get a rectal tube, nurses screaming at me to do something and saying that nightfloat wont answer pages for hours....this poor patient was just sitting there and no one knew fully what was wrong with him based on all the arguing on what his treatment should be--no one knew whether his belly could be decompressed or what..and everyone was afraid to try anything...thinking they'll perf his colon (i dont know why it would perf! it's not a colon problem! its ascites!)...i don't understand why no one just did a simple therapeutic paracentesis and get that belly downsized....that's all i really remember-it was a long time ago, but that day, he was pretty critical, SOB, and needed a central line.

That hospital had weird rules and residents would somehow not want to alleviate situations when they were critical, just protocols like residents only talk to ICU residents, and interns can only talk to their particular residents, not the ICU resident. So in not having a resident, I was up the creek and so was my patient.

usually people don't get in trouble especially if it is documented. i think i just had bad karma following me around or something, even though i always try to do good things.

the care there was so wishy washy..sometimes i didn't think they really knew what they were doing..once my attendign ordered a CT for a femoral head necrosis on a SSA patient instead of an MRI, because the guy was claustrophobic..and the radiologists were like u cant see that on CT, which is true,..that's not even protocol...and the attending was like have them do it anyways..i mean a lot of things made no sense....so many patients there passed away...check in but never check out.. things were in such disarray there. i was scared for the patients. i kept qustioning my attendings sometimes like in a subtle way and they wouldn't really give any explanations. i didn't want my patients to die on me because it's going to end up my fault. i think they were so overwhelmed because that hospital is pretty huge. so that's probably one of my problems i had there. i learned to be quiet after a while but it was maddening, because ur doing things that you know aren't going to help the patient and ur just like ok sure whatever u say...u feel like a partner in crime sometimes...i hated seeing weak patients go on traechs, one of them died after she got the surgery--they say the hospital gets more money if a patient is on a traech, but money shouldln't be an issue...this lady simply wasn't ready-her coags were out of whack..i think she ended up bleeding to death internally...(not my fault!)....but i think i just learned to be just a slave now and do what they say, until I get to the day I get out of residency and document it and say the attending told me to do it.
 
turquoiseblue said:
I would think at least documenting that you paged a senior and tried your hardest to get help shows that you at least call for help, whether they answered the call or not, and then documenting (as a brief SOAP note) what you did should help if anyone is in question that you even did anything at all.

If others want to scrutinize what was done, that is another story. As long as you discussed with a senior that should say it all and defer all blame to the senior to cover themselves from there. ;) (no offense to the seniors).
The senior could then write another note or the resident could write that the senior agreed with their plan, or reassess as discussed with the senior. That way everyone is covered.

****
I've once asked another senior in ICU for help on the wards, because a patient was crashing--i thought he should go to the ICU and it turns out he really did, but the ICU resident wouldn't even bother to listen, because he was worried about his other patients, and he would not help me because he wasn't my resident..I actually didn't have a resident that night for some reason...i think it was that i was working overtime because the nightfloat guy woudln't come answer his pager for hours, so officially i was supposed to be gone, but no one was caring for this crashing dying patient. I stayed there out of concern whether I was supposed to or not--i just didn't want this patient to die out of neglect. (later on i was called to the PD's office and got in trouble even though i was trying to save this guy's life..i mean i saw so many patients die on nightfloat, so I didn't like to leave my patients).

I actually walked down to the ICU to tell this ICU resident off because who leaves people to die in a hospital like that.because he kept blowing me off on the phone..not believing me....eventually he understood and called a resident up there....about an hour later the ICU resient calls in for someone else to come up (which took a long time for him to get up there), but during that one hour he was arguing with me how he can't even deal with that problem and I have to have a resident call him first, and that I cant call him. I didn't have a resident so I was so scared this patient was going to die due to crazy politics. He was my day patient so I didn't want him to die because nightfloat doesn't want to deal with him. He was HIV , a hard stick, SOB, ascitic, his ABG was out of whack, sats dropping, couldn't get a CT because he didn't have the veins to get contrast (was an IV drug abuser), GI was arguing with surgery daily whether he should get a rectal tube, nurses screaming at me to do something and saying that nightfloat wont answer pages for hours....this poor patient was just sitting there and no one knew fully what was wrong with him based on all the arguing on what his treatment should be--no one knew whether his belly could be decompressed or what..and everyone was afraid to try anything...thinking they'll perf his colon (i dont know why it would perf! it's not a colon problem! its ascites!)...i don't understand why no one just did a simple therapeutic paracentesis and get that belly downsized....that's all i really remember-it was a long time ago, but that day, he was pretty critical, SOB, and needed a central line.

That hospital had weird rules and residents would somehow not want to alleviate situations when they were critical, just protocols like residents only talk to ICU residents, and interns can only talk to their particular residents, not the ICU resident. So in not having a resident, I was up the creek and so was my patient.

usually people don't get in trouble especially if it is documented. i think i just had bad karma following me around or something, even though i always try to do good things.

the care there was so wishy washy..sometimes i didn't think they really knew what they were doing..once my attendign ordered a CT for a femoral head necrosis on a SSA patient instead of an MRI, because the guy was claustrophobic..and the radiologists were like u cant see that on CT, which is true,..that's not even protocol...and the attending was like have them do it anyways..i mean a lot of things made no sense....so many patients there passed away...check in but never check out.. things were in such disarray there. i was scared for the patients. i kept qustioning my attendings sometimes like in a subtle way and they wouldn't really give any explanations. i didn't want my patients to die on me because it's going to end up my fault. i think they were so overwhelmed because that hospital is pretty huge. so that's probably one of my problems i had there. i learned to be quiet after a while but it was maddening, because ur doing things that you know aren't going to help the patient and ur just like ok sure whatever u say...u feel like a partner in crime sometimes...i hated seeing weak patients go on traechs, one of them died after she got the surgery--they say the hospital gets more money if a patient is on a traech, but money shouldln't be an issue...this lady simply wasn't ready-her coags were out of whack..i think she ended up bleeding to death internally...(not my fault!)....but i think i just learned to be just a slave now and do what they say, until I get to the day I get out of residency and document it and say the attending told me to do it.
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I'll be honest, I did not read this entire thing.. but hearing that you think the patient is dieing, you have no upper level returning calls, the ICU resident/fellow is refusing to talk to you....have you ever heard of an Attending? And if the one on call does not return the call, call the director/PD/chairmen/anyone... say, hey I am stuck here, here is my problem NOBODY will call me back... I assure you would then hear back from someone. I would hope another attending would tell you what to do or personally come the hospital to save the day.....


Back a few posts you made some long reference about a nurse and a needle left out. Learn to play the game, dont argue. If a nurse told me I left a needle out, and yet I *KNEW* i chunked it, I would tell her oh my I was certain I chunked that in the sharps container; I'll go get it right now before anyone gets hurts... I assume they pipe up and say that they already put it in the sharps container, thats your chance to smile and say thank you soo much, what would we do if we did not have people like you hear to keep us inline!

So now you went from complaint to man he's our favorite resident this month. Part of being a doctor, and espically one LOW on the totem pole, is biting your lip and making bad situations good. Understand?
 
turquoiseblue said:
I would think at least documenting that you paged a senior and tried your hardest to get help shows that you at least call for help, whether they answered the call or not, and then documenting (as a brief SOAP note) what you did should help if anyone is in question that you even did anything at all.

If others want to scrutinize what was done, that is another story. As long as you discussed with a senior that should say it all and defer all blame to the senior to cover themselves from there. ;) (no offense to the seniors).
The senior could then write another note or the resident could write that the senior agreed with their plan, or reassess as discussed with the senior. That way everyone is covered.

****
I've once asked another senior in ICU for help on the wards, because a patient was crashing--i thought he should go to the ICU and it turns out he really did, but the ICU resident wouldn't even bother to listen, because he was worried about his other patients, and he would not help me because he wasn't my resident..I actually didn't have a resident that night for some reason...i think it was that i was working overtime because the nightfloat guy woudln't come answer his pager for hours, so officially i was supposed to be gone, but no one was caring for this crashing dying patient. I stayed there out of concern whether I was supposed to or not--i just didn't want this patient to die out of neglect. (later on i was called to the PD's office and got in trouble even though i was trying to save this guy's life..i mean i saw so many patients die on nightfloat, so I didn't like to leave my patients).

I actually walked down to the ICU to tell this ICU resident off because who leaves people to die in a hospital like that.because he kept blowing me off on the phone..not believing me....eventually he understood and called a resident up there....about an hour later the ICU resient calls in for someone else to come up (which took a long time for him to get up there), but during that one hour he was arguing with me how he can't even deal with that problem and I have to have a resident call him first, and that I cant call him. I didn't have a resident so I was so scared this patient was going to die due to crazy politics. He was my day patient so I didn't want him to die because nightfloat doesn't want to deal with him. He was HIV , a hard stick, SOB, ascitic, his ABG was out of whack, sats dropping, couldn't get a CT because he didn't have the veins to get contrast (was an IV drug abuser), GI was arguing with surgery daily whether he should get a rectal tube, nurses screaming at me to do something and saying that nightfloat wont answer pages for hours....this poor patient was just sitting there and no one knew fully what was wrong with him based on all the arguing on what his treatment should be--no one knew whether his belly could be decompressed or what..and everyone was afraid to try anything...thinking they'll perf his colon (i dont know why it would perf! it's not a colon problem! its ascites!)...i don't understand why no one just did a simple therapeutic paracentesis and get that belly downsized....that's all i really remember-it was a long time ago, but that day, he was pretty critical, SOB, and needed a central line.

That hospital had weird rules and residents would somehow not want to alleviate situations when they were critical, just protocols like residents only talk to ICU residents, and interns can only talk to their particular residents, not the ICU resident. So in not having a resident, I was up the creek and so was my patient.

usually people don't get in trouble especially if it is documented. i think i just had bad karma following me around or something, even though i always try to do good things.

the care there was so wishy washy..sometimes i didn't think they really knew what they were doing..once my attendign ordered a CT for a femoral head necrosis on a SSA patient instead of an MRI, because the guy was claustrophobic..and the radiologists were like u cant see that on CT, which is true,..that's not even protocol...and the attending was like have them do it anyways..i mean a lot of things made no sense....so many patients there passed away...check in but never check out.. things were in such disarray there. i was scared for the patients. i kept qustioning my attendings sometimes like in a subtle way and they wouldn't really give any explanations. i didn't want my patients to die on me because it's going to end up my fault. i think they were so overwhelmed because that hospital is pretty huge. so that's probably one of my problems i had there. i learned to be quiet after a while but it was maddening, because ur doing things that you know aren't going to help the patient and ur just like ok sure whatever u say...u feel like a partner in crime sometimes...i hated seeing weak patients go on traechs, one of them died after she got the surgery--they say the hospital gets more money if a patient is on a traech, but money shouldln't be an issue...this lady simply wasn't ready-her coags were out of whack..i think she ended up bleeding to death internally...(not my fault!)....but i think i just learned to be just a slave now and do what they say, until I get to the day I get out of residency and document it and say the attending told me to do it.
Click to expand...


I'll be honest, I did not read this entire thing.. but hearing that you think the patient is dieing, you have no upper level returning calls, the ICU resident/fellow is refusing to talk to you....have you ever heard of an Attending? And if the one on call does not return the call, call the director/PD/chairmen/anyone... say, hey I am stuck here, here is my problem NOBODY will call me back... I assure you would then hear back from someone. I would hope another attending would tell you what to do or personally come the hospital to save the day.....


Back a few posts you made some long reference about a nurse and a needle left out. Learn to play the game, dont argue. If a nurse told me I left a needle out, and yet I *KNEW* i chunked it, I would tell her oh my I was certain I chunked that in the sharps container; I'll go get it right now before anyone gets hurts... I assume they pipe up and say that they already put it in the sharps container, thats your chance to smile and say thank you soo much, what would we do if we did not have people like you hear to keep us inline!

So now you went from complaint to man he's our favorite resident this month. Part of being a doctor, and espically one LOW on the totem pole, is biting your lip and making bad situations good. Understand?

You have to learn to play parts of the game; being humble espically with those theoretically below you certainly helps. When a nurse wants to tell/teach you something.. listen. They DO know much, and even if its not much of anything, act interested and engage...that goes a long ways. When I need to go to a nurse, I tell them I am the stupid intern that needs help with whatever. They always reply or comeon your not stupid let me show you or whatever. I assure you they like that better than a barking order...

EDIT: And on documenting about notified R3 or whatever, I certainly see no problems with that. I documented that all the time when I was in situations where I called superiors. In several ICUs I was alone, so if things were bad, I called the attending at home... I would document that I spoke with Dr so and so and our plan is xyz. Its CYA and I think its simply good practice. I dont want the trauma team coming in the next morning and say WTF did this 'ER intern' do this for... they see the note that says Dr Attending advised it...

The other thing I see residents getting soo pi**ed about is being told to do things that they absolutly think are wrong. While I believe its great for us to be formulating what we do in certain situations, we do need to remember our a** is really never on the line. And if you have that much of a hangup about a treatment plan, there is NOTHING wrong with a few sentences stating that such and such was discussed with attending, plan is to whatever.
 
Great advice EM rebuilder..
u should write an intern handbook.

i think the whole thing with the nurse was weird bc she asked me if i would do it again...and i got philosophical and said i dont want it to but u never know...they took it as a yes..What do they care they just want u to say yes or no i guess. i should have said no. after i said that they sent up a report..shes the same woman that didnt do an iv first before calling me as per protocol..i let it slide and did it anyways... i couldnt get it cuz she was an HIV ivda and a hard stick..she needed hr vanco by midnight and the lazy day resident dumped it on me at night...i asked if she could get po for the night since we had no iv access...the answer was no..iv only...actually poor pt didnt have meds for days for being a difficult stick..and im the unsuspecting little dumpee nightfloater....that unthankful nurse still went against me in full throttle at the end...
i asked my cheif to help back me out of this..told him its really not fair..and that i waa helping het get an iv..no one helped me get the iv..it was just me.... and he took her side and didnt do anything...grrr. thats the part when i was really disapponted. the next day boom..write ur rebuttal...they had a meeting involving the ceo.without me..the report went there beyond the pd's....via that nurse.they tried to play up the needle thing as something dreadfully serious but never proved it was mine...and im sitting there thinking no this is not happening! i think i wrote in my rebuttal that i recall throwing sharps away. but that didnt change anything bc one of the chiefs was once stuck and was on HIV meds for 6 to 9 months...so they took it personaly.....no one was stuck in my case but they just kept saying it had the potential..etc etc..depite the fact that immediate meds dramatically reduce the chance for transmission...to a matter of .3% if im not mistaken.

so always answer with a yes or no...ppl dont seem to interpret shades of gray accurately...
 
michaelrack,
there may have been a contraindication.....oh actually he had terrible coags so that may be why..everytime we tried to do an iv he would bleed a lot. it was a no win situation. no contrast ct no paracentesis...so no one fully knew what was going on with him...in the icu they finally managed to decompress his belly maybe with the rectal tube... but he still died a week or so later :( i think interns first need to get certified to do paracentesis..and then maybe get to do on their own.
 
ok,
Here're my recap:
1. Paracentesis is a procedure and the hospital is not allowed to bill Medicare/Medicaid unless an attending is present and available, supervising the procedure. Yes, we have done procedures all the time as residents with no attending available. And yes, the hospital bills for them. And occasionally they do get caught and when they do, all hell breaks loose in the CFOs office because the penalties usually include a medicare/medicaid fraud assessment on top of it. Is the rule reasonable? Not for me to say. It is what it is.

2. turquoise, your situation, hospital and staffing/pecking order is probably not as uncommon as we would all like to hope. This is probably not the best place to start bringing up the nuances of the care at your institution. While it is cathartic to vent and rehash, I think you need to be very circumspect on what you post on this or any public forum. Residency can be a minefield and knowing what to look for is important, but getting into the firing mechanism of the mine is probably not helpful.

3. Tired is 100% absolutely correct. I cannot emphasize this enough. I had a crosscover patient that was simply signed out as "fractured hip admitted for pain management -No issues." Well, it turned out there were issues and I got called. Admit HP said about the same in about that much detail. When pt crashed, I called for the old med-rec and found an amazing story that explained much about what was going on with the patient, managed the issue and write a very detailed note, concluding with Discussed with senior call resident who concurs with management plan. In essence I was the one who did a full admit w/u on the pt who had been in for several days. That detailed note, concluding with that remark ended up saving my butt, my year and possibly my career. Not all attendings have the same specialized knowledge you learned in med school or elsewhere and they may be ignorant of certain facts/studies from time to time. So are we all. The good ones listen, the bad ones don't, but regardless of this as anothe post said, they are the attending and what they say goes. That is why the phrase on any plan especially for a PGY1 but also for all of us throughout our residency, "Discussed with Dr. Bossman-Bosswoman who concurs with the assessment and plan." is a life saver.

There are two phrases I learned in the service of our government, One not true and the other absolutely true:
False: "I'm from the government and I'm here to help you." To correct, substitute your verb of choice.
True: "If it isn't documented it didn't happen."

Again, Tired is 100% correct. Pay attention. Documentation is everything, not to pass the buck up the chain of command, but to protect everyone from what might happen.

Oh, and be nice to the nurses and include them in your care plan discussions so they understand the why of what you/your team are doing as well as the what.
 
Turq,

I think one of the hardest things for me to learn has been working with all the dynamics of the hospital team, as well as trying to just smile and 'get along' with everyone, and I mean everyone. All these tips for being nice to mean nurses, or not reacting when someone leaves you hanging, or dumps serious problems on you or whatever - it is freakin' hard to just suck it up and not say anything. I learned pretty quickly that anything, ANYTHING I said or did could and would be taken out of context and held against me. Depending on the person or the situation.

It sounds ridiculous, but thats the way it is. I went from being a happy, friendly person to one who is quiet and very, VERY careful in what I say. Outside the hospital I am can be myself, inside I become a different person. I am detached, polite but I say only bland, almost meaningless things. I also lie, alot. Not about important clinical things, but to nurses and staff who are working on me. I lie to their faces, smile and say - thank you for pointing that out, you are so nice to do that!

Sometimes, I act like I am sort of 'slow,' and half-witted. Like I don't 'get it,' when someone is rattling my cage. We all have to do the work, and play the game. You can do it to.

As for getting back to residency, do some soul-searching and ask yourself what you want to do, what can you do and how can you get there. Then, make a plan, get very honest, and humble and one step at a time move towards that goal. There may be that one spot for you somewhere, do your best to be that excellent resident who is incredibly grateful for a second chance.
 
Persia,
I totally agree with you on the way to act in residency. It truly is a game that has to be played to get through. I sure hope there is a spot out there for me with my name on it and that I get a second chance! Thanks for the great insightful advice.
 
3dtp said:
ok,
Here're my recap:
1. Paracentesis is a procedure and the hospital is not allowed to bill Medicare/Medicaid unless an attending is present and available, supervising the procedure. Yes, we have done procedures all the time as residents with no attending available. And yes, the hospital bills for them. And occasionally they do get caught and when they do, all hell breaks loose in the CFOs office because the penalties usually include a medicare/medicaid fraud assessment on top of it. Is the rule reasonable? Not for me to say. It is what it is.

.
Click to expand...

When I was a resident, we occasionally did procedures without the attending present and just didn't bill for it. I guess the hospital just ate the cost for the procedure tray.
 
Here's a thought. Have you thought about another field, like dentistry?
 
I don't think I can even think of another field. I tried research and its like :p. I don't think dentistry is in my interests, although it is a nice high paid field.

I have thought about redoing medical school altogether in the US.......but i dunnoo---another 4 years! I'll be in my late 30's when I finish though. I don't even know if I'd get in. Maybe its going to take 4 yrs to get residency anyways.

I haven't done anything in the past year except study for step 3 due to my inability to find a relevant job..plus being ill for some of that time (now recovered)......how bad is that going to look to a program?
 
turquoiseblue said:
Great advice EM rebuilder..
u should write an intern handbook.

i think the whole thing with the nurse was weird bc she asked me if i would do it again...and i got philosophical and said i dont want it to but u never know...they took it as a yes..What do they care they just want u to say yes or no i guess. i should have said no. after i said that they sent up a report..shes the same woman that didnt do an iv first before calling me as per protocol..i let it slide and did it anyways... i couldnt get it cuz she was an HIV ivda and a hard stick..she needed hr vanco by midnight and the lazy day resident dumped it on me at night...i asked if she could get po for the night since we had no iv access...the answer was no..iv only...actually poor pt didnt have meds for days for being a difficult stick..and im the unsuspecting little dumpee nightfloater....that unthankful nurse still went against me in full throttle at the end...
i asked my cheif to help back me out of this..told him its really not fair..and that i waa helping het get an iv..no one helped me get the iv..it was just me.... and he took her side and didnt do anything...grrr. thats the part when i was really disapponted. the next day boom..write ur rebuttal...they had a meeting involving the ceo.without me..the report went there beyond the pd's....via that nurse.they tried to play up the needle thing as something dreadfully serious but never proved it was mine...and im sitting there thinking no this is not happening! i think i wrote in my rebuttal that i recall throwing sharps away. but that didnt change anything bc one of the chiefs was once stuck and was on HIV meds for 6 to 9 months...so they took it personaly.....no one was stuck in my case but they just kept saying it had the potential..etc etc..depite the fact that immediate meds dramatically reduce the chance for transmission...to a matter of .3% if im not mistaken.

so always answer with a yes or no...ppl dont seem to interpret shades of gray accurately...
Click to expand...

I feel really bad that you don't seem to understand why things happen to you or why people are getting upset at you with your performance which appears to be poor in some areas. I would be enragged to have to work with someone like you who leaves out needles and gives a flimsy-pimsy answer as to why you did it, and then passively describes "potential" for harm!!! Your description of these events is very confusing and you describe the actions of the senior residents and attendings from the perspective of a child almost i.e. rebutting that you throw away sharps sometimes means you don't take responsibility for what you may have done.(no offense but I could not work with someone who seems to explain away everything like you do in this post, I hope this isn't your real personality) . . . I would suggest that you get a job where you can learn to be more responsible and realize that medicine may very well not be for you, which is OK, you will likely drive a lot of people crazy that you work with in medicine who care more about the details (99% of people in medicine). A "physician" or a resident who is going to be allowed to pass each year doesn't describe a "whole thing with a nurse" as "weird", you have to understand you were very lucky to get a residency to begin with, and that in your post you are coming off really bad, and don't have the attitude of a doctor or a doctor in training, which is what you were. I would be really angry if I was the chief who was on hiv meds for 6 to 9 months and found out you just described it as something taken "personally" as HIV medications will reduce my risk. The nurse got mad at you because you project the image of a person who does not care about making mistakes that might harm other people! (I know you may not means this but this tone is very persistent in your post) if you just care about making money then go into another field as you will always be irked by people who take offense with your apparently sloopy work habits.
 
turquoiseblue said:
I don't think I can even think of another field. I tried research and its like :p. I don't think dentistry is in my interests, although it is a nice high paid field.

I have thought about redoing medical school altogether in the US.......but i dunnoo---another 4 years! I'll be in my late 30's when I finish though. I don't even know if I'd get in. Maybe its going to take 4 yrs to get residency anyways.

I haven't done anything in the past year except study for step 3 due to my inability to find a relevant job..plus being ill for some of that time (now recovered)......how bad is that going to look to a program?
Click to expand...

I would seriously consider looking at dentistry, pharm, etc. if you are competitive enough to get in.

Redoing med school here is a non-starter. That won't happen. I agree with the other posters that I don't get the sense that you're a good fit for medicine. I would try to contact as many PD's as I possibly can and give it one last shot to get into a FP, IM, or psych program. If that fails, then it's time to move on with your life.
 
turquoiseblue said:
I have thought about redoing medical school altogether in the US.......but i dunnoo---another 4 years! I'll be in my late 30's when I finish though. I don't even know if I'd get in.
Click to expand...
You cannot matriculate in a US medical school if you have already been conferred an MD degree.
 
I would say go to a PA school. It's shorter than med school, costs much less, and you have the medical knowledge to pass it. You'll earn money while trying to sort out how to fix this... might eventually get enough influence to become a resident if you sink yourself as a PA into a program.

I dont blame you for what happened because it's true you will get blackballed. Unfortunately, your case is not unique and our system is so bad that quiting internship makes you near dead in medicine... You are better off NOT matching than quiting an internship. Being FMG that pounds nails into your coffin.

PS: Step 3 is a must now a days.

Best of luck.
 
Tired said:
Unless you document it.

The nurses CYA every fricking hour of every day. So should we.

When you have a situation serious enough that you have to call your senior, drop a note in the chart. It doesn't have to be anything more than a couple sentences.

"Called by RN for hypotension. Assessed patient, BP 80/40, delerious. Meds reviewed, no recent narcotics, metoprolol 50mg PO last administered 1hr ago. Normal temp. Physical exam unchanged. Started fluids, ordered q15min BP x 2hrs, requested RN call for any change in clinical status. Notified R3 on-call of patient's status."

I have seen interns avoid playing the scapegoat for putting these kinds of notes in the chart, and I do it religiously.
Click to expand...

Great post. Documentation is so important. Someone may not agree with your plan, but if you outline one, and noted a discussion you are covered.
 
Throughout this entire thread you take very little responsiblity for what has happened (if the nurse never tried an IV who else would have left a needle in the room?). I wasn't there so I wont judge. I agree with many others a few stumbles early on can really trip you up. At the very least communication needs to improve. Some attendings point out the 3 A's of being a good surgeon. Affable, Available, and Able. To be a good resident I would add Accountable. I've ended a few verbal beatdowns with the "I sorry. It was my fault. It will never happen again", even when its not my fault.

The facts, as far as I can tell, that will appear in your application are
1. you are a fmg
2. you scrambled your first match
3. you scored low on your step exams
4. you left one residency midway through (left for personal reasons is doubtful to be a justification for many interviewers. Just like you substituted unsatisfactory, for suboptimal in the OP, they would substitute the worst possible thing)
5. you don't have strong LOR
6. you scored poorly on inservice (may not be in your application)

This is a large body of evidence against accepting you into a residency program. You need to minimize their risk, and there is little to nothing you can do to change the above except for LOR's. I would suggest that you try for a prelim spot. I think this may limit the perceived risk to the program. After a prelim year you may be accepted as a categorical resident at your prelim program or you can try again in the match with new LOR.
 
barcalounger said:
You cannot matriculate in a US medical school if you have already been conferred an MD degree.
Click to expand...

I asked one school and they said yes I could..possibly because my MD is from a foreign school.
 
about the whole nurse thing...whatever--because a nurse once tried to draw blood from me and left a needle in there with me...i mean she didn't know i was a doctor either. what if i stuck myself? same principle here. so seems ilke its no big deal everywhere else but me? well, i beg to differ. i should be treated like anyone else.

at that hospital i saw residents leave open cath sets laying next to patients and left the room for prolonged periods of time, and that's okay?

I saw needles in patients' drawers---is that okay? I don't think so.

I told them what I saw and the example I had to follow being a new intern there...and they didn't seem to acknowledge that and acted like still im in deep trouble just because this particular nurse dind't like me. i had switched calls with another resident so some of the nurses I hadn't known before.
she wanted my new year's vacation and I stupidly gave it to her only to find out my job will be clobbered by nurses on her shift. I think the shift change really messed things up because these nurses weren't used to me, they were used to her and expected to see her that very night.

That was the first time I had switched calls there with anyone.

this particular nurse was new. she was very judgemental...the rest were normal. I believe she had a problem the way she kept talking to me. She was yacking at me all night in a rude manner over anything and everything--no one else acted that way. She could have even been a temp from another hospital. It was just late at night--she was really cranky.

I clearly remember throwing away my sharps--i meticulously did so every time. I don't know where anyone gets the notion that I was lazy or anything. I did all I could the best I could. I've walked in on a SSA patient and seen tons of needles laying on a bed that a nurse left.

You never know it could have been a few days old, left by a nurse and suddenly found later. I dont think that without proof I should be fully blamed, and besides be the only one blamed when everyone else had done worse. Even so, this is ridiculous. I don't care what anyone has to say about me just because of this one thing as a starting intern--this doesn't happen to anyone. she reports me to the CEO. I mean she really wanted to ruin me. She has no authority whatsoever to ruin my job, but i think that is the only powertrip those nurses had there to feel like they are in control, although I gave them all the control in the world. She was so OCD she didn't get what I meant when I said it the first time. She only sees black and white--yes or no...and doesn't have a clear interpretation of my answer to her. I did apologize ,said sorry, it won't happen again, and still she was on my back over my many incoming pages--didn't care about it, so I walked off because anything I said was wrong to her..she's just an insane woman, that's all i see and her main aim is to win..and if she doesn't she makes sure she wins by ruining someone's job. she could have gotten in trouble for not trying the iV before asking me. i mean that is her job and she's dumping it on me and I did it even though other residents would never do that for a nurse and make sure she does it first...i even saw them do that, yet I am the one that gets pushed around like that and still lick the floor for them and still am dead for that. she's just a thankless woman. i was more than nice to her.

Anyways...if anyone thinks she was in the right i am sorry...there's something wrong with that. and to think i am not fit for medicine well i think that's going a little too far to say that. i'm still trying regardless.
 
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